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Breast imaging readers' performance in the PERFORMS test-set based assessment scheme within the MyPeBS international randomised study
No full textPurpose: A survey conducted by the European Society of Breast Imaging (EUSOBI) in 2023 revealed significant variations in Quality Assurance (QA) practices across Europe. The UK encourages regular performance monitoring for screen readers. This study aimed to assess the variability in diagnostic performance among readers participating in a wider prospective randomised trial across multiple countries. Method: In this retrospective multinational study, breast imaging readers from the MyPeBS clinical trial examined a test set of 40 challenging breast screening cases using the PERFORMS software, from March 2021 to February 2022. The challenging set, enriched with biopsy-proven cancers, aimed to differentiate readers by their level of diagnostic performance. Cancer detection and correct return to screen rates were calculated for each participant. Results: A total of 110 readers from 6 countries completed the PERFORMS test set, while 88 also completed an accompanying questionnaire collecting information about their breast screening work and experience. The study revealed variability in cancer detection rates (M = 73.6 %, SD = 19.7 %, range 0.0 %-100.0 %) and correct return to screen rates (M = 79.7 %, SD = 10.5 %, range 46.4 %-100.0 %). Outliers with extremely low cancer detection (2.7 % of participants) and correct return to screen rates (1.8 % of participants) were also identified. Conclusions: Breast imaging readers' performance in test set-based assessments like PERFORMS can reflect real-world screening proficiency. The presence of outlier readers with low diagnostic performance on the test highlights the need for double reading and for standardised QA protocols to ensure patient safety and service efficiency.The current study is funded as part of the MyPeBS clinical trial, which is supported by the European Union's Horizon 2020 Research and Innovation Programme under grant agreement No. 755394. The funders had no role in in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the manuscript for publication
Empatia, comunitat i crítica a l’excepcionalisme americà a Lincoln al bardo de George Saunders
No full textTreball de Fi de Grau en Humanitats. Curs 2024-2025Tutor: Pere Gifra AdroherEn el context social i polític actual, en què el pensament crític és fonamental per confrontar els discursos d’odi, la literatura esdevé un eix vertebrador en la lluita per qüestionar els relats hegemònics i obrir espais per a l’empatia i la transformació. Aquest Treball de Fi de Grau d’Humanitats és una anàlisi de la crítica a l’excepcionalisme nordamericà que George Saunders articula a Lincoln in the bardo (2017). Aquesta novel·la desafia alguns dels mites fundacionals més arrelats de la cultura estatunidenca per il·luminar i donar veu a la dimensió silenciada del relat nacional, a través d’un espai liminar entre la vida i la mort i una estructura coral o polièdrica. Prenent com a punt de partida aquest mythos nacional, es desglossa el text per identificar les estratègies narratives i temàtiques de l’autor per subvertir relats com el de la Terra Promesa, els Pares Fundadors, el gresol de cultures i l’home fet a si mateix
Metraje-error
No full textTreball de fi de màster en Estudis de Cinema i Audiovisual ContemporanisTutor: Sergi SánchezEl metraje-error es una imagen que fracasa en serlo: no informa, no entretiene, no vigila. Sin embargo, existe, expresa y forma parte del imaginario colectivo. Esta investigación es una ontología y manifiesto a favor de este tipo de metraje que escapa por completo las posibilidades de capitalización y que, por tanto, es capaz de crear nuevas lógicas de pensamiento basadas en la empatía alrededor de las imágenes basura.
Ante la urgencia de un nuevo régimen visual menos hostil, investigar el metraje-error implica abogar por la podredumbre de todas las cosas y confiar en las posibilidades de apertura que ofrecen los errores y grietas en el metraje digital. Este texto pone a dialogar los metrajes-error de piezas consagradas de Farocki, Herzog y Varda, entre otros, con varias obras audiovisuales que escapan a las doctrinas académicas encontradas sobretodo en YouTube y en varios directorios de videovigilancia.Metraje-error (footage-error) is an image that fails to be: it doesn't inform, it doesn't entertain, it doesn't monitor. However, it exists, it expresses, and it forms part of the collective imagination. This investigation is an ontology and manifesto in favor of a type of footage that completely escapes the possibilities of capitalization and is therefore capable of creating new logics of thought based on empathy around trash images. Faced with the urgency for a new, less hostile visual regime, investigating footage-error implies advocating for the rottenness of all things and trusting the possibilities of
openness offered by the errors and cracks in digital footage. This text brings the footage-error from established pieces by Farocki, Herzog, and Varda, among others, into dialogue with several audiovisual works that escape the academic doctrines found primarily on YouTube and in various video surveillance databases
Ambient air pollution, urban green space and childhood overweight and obesity: A health impact assessment for Barcelona, Spain
No full textBackground: The burden of childhood overweight and obesity attributable to ambient air pollution and a lack of urban green spaces (UGS) remains unknown. This study aimed to estimate the attributable cases of childhood overweight and obesity due to air pollution and insufficient UGS exposure in Barcelona, Spain. Methods: We applied a quantitative health impact assessment approach. We collected childhood overweight and obesity prevalence levels and exposure data from 69 spatial basic health zones in Barcelona. We estimated particulate matter (PM2.5) and nitrogen dioxide (NO2) levels using land use regression models, normalized difference vegetation index (NDVI) levels using remote sensing and percentage of green area (%GA) using land use. We estimated relative risks, population attributable fractions, and preventable overweight/obesity cases in children under following scenarios: Compliance of World Health Organization (WHO) air quality guidelines (AQGs) for (1) PM2.5 and (2) NO2; achieving (3) city-target NDVI levels and (4) 25% green area (%GA) recommendations. The analyses were stratified by socioeconomic deprivation index (in quintiles). Uncertainty was quantified using Monte Carlos simulations. Results: Compliance of WHO AQGs could prevent 0.4% [253 (95%CI, -604; 1086)] and 4.2% [3000 (95%CI, 1009; 4943)] of childhood overweight/obesity cases due to excess PM2.5 and NO2 levels in Barcelona, respectively. Compliance of NDVI and %GA targeted levels could prevent 6% [4094 (95%CI, 1698; 6379)] and 10% [6853 (95%CI, 1440; 12779)] of childhood overweight/obesity cases respectively. The preventable burdens of childhood overweight/obesity cases were slightly higher in middle-class socioeconomic areas due to the higher adverse exposure levels at baseline (high air pollution, less UGS). Discussion: Compliance with WHO AQGs and achieving UGS targets can reduce childhood overweight and obesity levels in Barcelona, and potentially in other locations as well. This underscores the need for policies that foster healthier urban environments of high environmental quality in order to protect child health
Evaluating the implementation of PROMs and PREMs in routine clinical care: co-design of tools from the perspective of patients and healthcare professionals
No full textBackground: Implementation of patient-reported measures (PRMs) is an integral element for patient-centered models; however, there is still hardly any quantitative evidence regarding its impact in routine care settings. The objective of this study was to codesign two concise tools that allow for a standardized and longitudinal assessment of the implementation of PRMs in routine care in terms of acceptability and perceived value from the perspective of both patients and healthcare professionals. Methods: A list of constructs and items to be presented, separately, to patients and healthcare professionals was created from evidence gathered through a narrative literature review. Focus groups, composed of either patients or healthcare professionals from different chronic conditions, were conducted for the co-design of independent assessments. Once agreement was reached, the content validity was examined in separate consensus meetings. Results: A total of 10 patients and 10 healthcare professionals participated in the focus groups. After 7 focus groups, the PRMs Implementation Assessment Tool for patients (PRMIAT-P) was developed with 33 items in 9 constructs, and the tool for healthcare professionals (PRMIAT-HP) had 33 items in 16 constructs. Content validity was confirmed for both tools. Conclusions: The perspective of patients and healthcare professionals regarding the implementation of PRMs in routine care can be evaluated quantitively with the PRMIAT tools. These tools are understandable, concise and comprehensive, and can be used in multiple settings and for different chronic conditions. They have been codesigned as a standard set to facilitate both longitudinal assessments and performing benchmarking among different initiatives
Género, vivienda y salud: encuentros con la vivienda desde una perspectiva interseccional
No full textEl objetivo de esta tesis es ampliar la comprensión de la relación entre vivienda y salud desde una perspectiva interseccional, y analizar los mecanismos que operan en esta relación. Realizamos tres estudios: 1) una revisión crítica sobre la literatura científica publicada, que evidenció la falta de perspectiva género en el abordaje de la relación entre vivienda y salud, invisibilizando desigualdades en sus efectos; 2) un estudio cualitativo que reportó diferencias, según género y situación residencial, en concepciones y prácticas asociadas a la vivienda, operando como mecanismos en las desigualdades de salud; y 3) un estudio cuantitativo que reveló diferencias poblacionales en los efectos sobre la salud de la conciliación de cargas de trabajo productivas y reproductivas, según las intersecciones entre género, situación residencial y clase social, con peores efectos para la salud en el caso de mujeres con inseguridad residencial.
Proponemos una adaptación al marco conceptual de la relación entre vivienda y salud, considerando las esferas de la vida cotidiana y la perspectiva de género interseccional. Ante el entramado de desigualdades del fenómeno residencial, urge un enfoque transdisciplinar e interseccional en su comprensión e intervención, que considere la importancia de la vivienda como elemento clave para el desarrollo de la vida.The aim of this thesis is to broaden the understanding of the relationship between housing and health from an intersectional perspective, and to analyze the mechanisms that operate in this relationship. We conducted three studies: 1) a critical review of the published scientific literature, which evidenced a lack of a gender perspective in the approach to the relationship between housing and health, making invisible the inequalities in its effects; 2) a qualitative study that reported differences, according to gender and housing situation, in conceptions and practices associated with housing, operating as mechanisms in health inequalities; and 3) a quantitative study that revealed population differences in the health effects of life-work balance, according to the intersections among gender, housing status, and social class, with worse health effects in the case of women with housing insecurity.
We propose an adaptation to the conceptual framework of the relationship between housing and health, considering the spheres of everyday life and the intersectional gender perspective. Given de complex of inequalities of the housing phenomenon, there is an urgent need for a transdisciplinary and intersectional approach in its understanding and intervention, which considers the importance of housing as a key element for the development of life.Programa de Doctorat en Biomedicin
A cost minimization analysis of the implementation of the international lung screening trial in Catalonia (Spain)
No full textBackground
NLST and NELSON trial showed that lung cancer mortality can be reduced by 20-24% using low-dose computed tomography screening, due to an increase in early-stage diagnoses.
Research question
How much lung cancer-related direct costs may be reduced using low-dose computed tomography screening based on the ILST-protocol in a public healthcare system?
Methods
Cost analysis of lung cancer screening vs. usual care in the framework of the retail price of the Catalan public healthcare system. The lung cancer screening group included costs of screening (ILST-protocol), treatment cost according to weighted average distribution of TNM staging in the NLST and NELSON trials, lung cancer detection rate and smoking-cessation intervention. The usual care group included treatment costs based on distribution of TNM staging registered in the Spanish index hospital.
Results
In the usual care group, treatment costs were €91,959. In 5-year of lung cancer screening program, the average expected costs per subject were €1,342 (range €1,054-1,832) for screening and €32,431 for treatment, with an expected reduction of €952 based on an average cancer detection rate of 1.6%. The decrease in cost resulting from the stage shift offsets 70.6% of the costs of the screening program.
Conclusions
The decrease in direct costs associated with lung cancer treatment due to a stage shift resulting from LCS of high-risk populations compensates for a substantial part of the LCS program costs.This work was supported by MINECO [Núm. Expedient: RTI2018-095209-B-C21-22]; Barcelona Respitatory Network (BRN)- Fundació Ramon Pla i Armengol; "Clinical project" grant, Fundació Acadèmia Ciències Mèdiques de Catalunya i de Balears; "Talents" grant 2020, Fundació La Pedrera and Hospital Universitari Germans Trias i Pujol
Sobre las manos de Juan Benet : una interpretación de su obra desde la hermeneútica crítica
No full textDesde la publicación de su primera novela, Volverás a Región (1967), uno de los lugares comunes de la crítica sobre la obra de Juan Benet es su innegable dificultad. Por otra parte, se ha reconocido su oposición respecto a los principios de la ciencia, de la filosofía y, en definitiva, del saber racional. Ello no supone, sin embargo, que el conjunto de su obra y las obras en su singularidad carezcan de un sentido determinable. El objetivo del presente estudio es mostrar que la constitución del sentido de la obra benetiana es indisociable de la voluntad, por parte del escritor, de obstaculizar su comprensión. La interpretación que aquí se lleva a cabo pretende «tomar partido por una toma de partido previa», siguiendo la disposición hermenéutica que practicó Jean Bollack. Tras una primera parte dedicada al singular libro Del pozo y del Numa (1978), la investigación se centra en las novelas y los ensayos nucleares del período de 1967- 1980, y termina estudiando la obra posterior a la publicación de Saúl ante Samuel (1980), entendiendo que el punto de inflexión que representa dicha novela no da paso sino a una rigurosa continuidad del sentido ininterrumpida hasta 1991.Since the publication of his first novel, Volverás a Región (1967), one of the commonplaces in criticism of Juan Benet’s work has been its undeniable difficulty. Furthermore, his opposition to the principles of science, philosophy and, in short, rational knowledge has been widely acknowledged. This does not mean, however, that his work as a whole, and the works in their singularity lack a determinable meaning. The aim of this study is to show that the constitution of the sense of Benet’s work is inseparable from the writer’s desire to obstruct its comprehension. The objective of this interpretation is to adopt a hermeneutic disposition in alignment with the one practised by Jean Bollack. After a first part devoted to the singular book Del pozo y del Numa (1978), the research focuses on the novels and essays of the period 1967-1980, and ends by studying the author’s work following the publication of Saúl ante Samuel (1980), in the understanding that the turning point represented by that novel only gives way to a rigorous continuity of meaning uninterrupted until 1991.Programa de Doctorat en Humanitat
The UN’s sustainable development goal 3 in Switzerland: assessing the efficiency of a leading global health care system
No full textBachelor's degree in Global Studies. Curs 2024-2025Tutor: Pol Dalmau PaletSwitzerland is renowned for being a society in which a high standard of living is ensured thanks to the accessibility to first-class services and participatory democracy, which protects human rights and ensures the inclusion of all citizens regardless of their background. Nonetheless, when it comes to the health care system, this tendency tends to reverse as there are no free state-provided health facilities, making Switzerland one of the most expensive countries in Europe for accessing this service.
The health care system is regulated by the Swiss Federal Law on Health Insurance, thus forming a mix of public and private insurance. The Swiss system portrays the country’s federal structure through the distribution of cantons for overseeing health care allocation; however, the health system does not receive funding from government taxes, but from insured premiums. The country's population indeed receive excellent quality and a wide variety of medical services, still, research reveals that OECD countries perform with similar results but at a lower cost.
In the following dissertation, we will take the approach of the third Sustainable Development Goal, ‘Good health and well-being’, to better understand the efficiency of the Swiss health system and analyse the following paradox: how is it possible that one of the best health care systems in the globe cannot guarantee free health care performance assuming a great expense for its residents; including new policy strategies such as DigiSanté or Health2030
La caja negra de la dinámica empresarial
No full textEste artículo intenta aportar conocimientos sobre la contribución a la política industrial de la investigación en dinámica empresarial. Los programas de fomento a la creación de empresas se han generalizado aunque se desconoce cuál es el ritmo óptimo de creación y destrucción empresarial. El análisis económico destaca la heterogeneidad empresarial como característica dominante en la dinámica industrial. La profundización en el conocimiento de los tipos de emprendedores, su comportamiento, y su contribución diferencial a la innovación y el crecimiento permitirá ver en la "caja negra" y diseñar programas públicos adecuados. El análisis empírico realizado encuentra que la naturaleza económica del autoempleo es muy diferente de las empresas con empleados. Los programas públicos deberían priorizar entrantes con capacidad de sobrevivir y no maximizar la entrada indiscriminadamente. La supervivencia de las nuevas empresas se encuentra positivamente relacionada con su tamaño al nacer. La innovación y la inversión mejoran la supervivencia de las nuevas empresas manufactureras. La inversión en I+D aumenta el riesgo de las nuevas empresas, aunque mejore la competitividad de las empresas establecidas.This article highlights the contributions of business dynamics research to industrial policy design. Business creation support programs are widespread des-pite the fact that the optimal rate of business creation and destruction remains unknown. Economic analysis emphasizes heterogeneity as the most salient characteristic of industrial dynamics. A better knowledge of the different types of entrepreneurs, their behavior and their specific contribution to innovation and growth would allow to see into ‘black box’ of business dynamics and would facilitate the design of appropriate public policies. The empirical analysis performed shows that self-employment has a quite different economic nature than business with employees. Public programs should not promote indiscriminate entry but rather give priority to able entrants with survival capacities. Survival of entrants is positively related to their size at birth. Innovation and investment improve the survival of new manufacturing firms. Investment in R&D increases the risk of failure in new firms, although it improves the competitiveness of the incumbents